Exchange Agent

Among health information exchanges, Grand Junction, Col.-based Quality Health Network is a rare bird  its actually flying. Incorporated in summer 2004, QHN became operational in the fall of 2005. Each month, it now routes hundreds of thousands of clinical messages  including lab results; radiology reports; referral requests; surgical and ER notes; progress notes; discharge summaries and other transcribed documents-to 340 area physicians, says Executive Director and CEO Dick Thompson. QHNs federated data brokerage model is sustained by contributions and fee-for-service revenue from three local acute care hospitals, area physicians and other providers, plus a local payer, Rocky Mountain Health Plans. We are in the shipping and receiving business, says Thompson, who attributes the data exchanges success as much to trust as technology.

On QHNs Reach

We reach nearly every category of provider in the county: acute care hospitals, surgical centers, ambulatory care providers, home health, public health, behavioral health, safety net providers, extended care facilities, urgent care centers, emergency departments and pharmacies. We touch a total of 84 organizations and more than 200 pharmacies. We cover nearly 3,500 square miles with a population of 150,000.

On Making HIEs Work

You have to achieve a level of trust among the participants. We have an unstated covenant that patient information exists to improve outcomes and is not to be used for proprietary purposes. Participants have to trust that their exchange partners wont violate that covenant.

On Privacy and Security

As an industry, we have to balance the need to share clinical information with appropriate privacy and security. Achieving the right balance takes time. It was a major obstacle for us.

On Tackling Privacy

We formed a community-wide privacy committee that met for many months. We spent a deal great of time on privacy and security and focused more on that rather than the technical aspects of health information exchange. We vetted our process at a very deep level before we turned the exchange on. All of us are patients and understand the need. On Catering to Physicians We deliver the data the way physicians want it delivered. If they want the data via fax, we route it that way. If they want output to a printer, we do it that way. We also offer a browser-based viewer, our EMR Lite,² or we can feed data directly into a physician¹s EMR system. More than 85% of the area physicians are connected to QHN, and among those, 30% are using their own EMR. On Involving Payers Measuring the value at this point is more art than science. Improving health care quality results in things that don¹t happenand it is difficult to measure things that don¹t happen. The local health plan continues to support us, even though we have not been in operation long enough to prove that the population is healthier because QHN exists. The health plan also is incentivizing physicians to report quality data on chronically ill patients, including diabeticswhich helps improve patient outcomes. QHN helps physicians report that data. For example, for diabetic care we can automate physician reporting of lab data, blood pressure data from the office visit, and whether or not a foot exam was done. Supporting us, however, is still an act of faith on the part of the health plan until more evidence can be gathered which proves an increase in quality is occurring. On the Future of HIEs It is bright. The cost of health care is escalating at an unsustainable rate. It is not prudent to have competing provider organizations duplicate servicesit usually doesn¹t cost less, it costs more. For example, why have two hospitals replicate the distribution of results to physicians? They can do a joint venture like ours, share the costs and save money. If a patient transitions from practice A to practice B, and practice B doesn¹t know what diagnostic test the patient had, the patient has to go through the same process, hassle and expense twice. This article can also be found at HealthDataManagement.com.